Audit of the STD/AIDS Prevention Program in the Department of Health

Report No.  93-29

Summary

The STD/AIDS Prevention Branch is part of the Communicable Disease Division of the Department of Health.  Its primary function is to prevent and control the spread of sexually transmitted diseases including AIDS in Hawaii.

With an annual budget of more than $8 million, the branch provides surveillance, prevention, detection, and treatment services to the public.  Some of these services are purchased from private providers under contract with the Department of Health.

We found that the branch has been meeting its stated goals and objectives.  However, it could carry out its mission more effectively if it had consistent leadership and direction.  Since the STD/AIDS program became a branch in 1989, it has had four chiefs, three of whom served in an acting capacity.  The absence of consistent leadership and direction has made it difficult for the branch to deal with pressing issues in planning, coordination, organization, and management controls.  The branch should have a strategy for changing circumstances, and branch activities need coordination.  The organizational structure lends itself to fragmentation and duplication, and the branch lacks a policies and procedures manual to provide guidance to its many sections.

We also found that the department is not administering properly its purchase of service contracts for STD/AIDS prevention services.  Contracts are not executed on time and payments are made late.  This puts the State at risk and sometimes requires private providers to obtain loans to carry them until their checks arrive.  In addition, contract monitoring and evaluation are inconsistent—the branch sometimes lacks sufficient documentation of provider activities.  The branch should have a monitoring and evaluation manual and standardized forms for contractors to submit their quarterly reports.

Recommendations and Response

We recommend that the Department of Health make hiring a permanent chief of the STD/AIDS Prevention Branch a priority.  The new chief should focus on developing a strategic plan, coordinating branch activities, ensuring that the branch is clearly and properly organized, and completing the policies and procedures manual.

The department should also improve the administration of purchase of service contracts by ensuring that contracts are executed and payments made in a timely manner.  It should give priority to analyzing the reasons for its poor contract management and making the needed corrections.  The department should continue its efforts to develop a monitoring and evaluation manual and quarterly report forms for providers.  It should ensure that quarterly reports are submitted by providers and secured at the branch.

The department feels our report and assessment accurately reflect the status of the program.  It says our recommendations correspond closely with its view of the strengths and need for improvement of the STD/AIDS Prevention Branch.